Exchange transfusion
 | This article needs additional citations for verification. (September 2014) |
| Exchange transfusion | |
|---|---|
| Other names | Exsanguination transfusion, replacement transfusion, substitution transfusion |
| ICD-9 | 99.01 |
| MeSH | D005078 |
| OPS-301 code | 8-801 |
| MedlinePlus | 002923 |
An exchange transfusion is a blood transfusion in which the patient's blood or components of it are exchanged with (replaced by) other blood or blood products.[1] The patient's blood is removed and replaced by donated blood or blood components. This exchange transfusion can be performed manually or using a machine (apheresis).[2]
Most blood transfusions involve adding blood or blood products without removing any blood, these are also known as simple transfusions or top-up transfusions.[3][4]
Exchange transfusion is used in the treatment of a number of diseases, including sickle-cell disease and hemolytic disease of the newborn. Partial exchange might be required for polycythemia.
Nearly all exchange transfusions are allogeneic (that is, the new blood or blood products come from another person or persons, via donated blood); autologous exchange transfusion is possible (using autologous blood banking), but there are not many situations in which a need for it arises, as most autologous transfusions involve no exchange.
Description
An exchange transfusion requires that the patient's blood can be removed and replaced. In most cases, this involves placing one or more thin tubes, called catheters, into a blood vessel. The exchange transfusion is done in cycles: each one usually lasts a few minutes.[1]
The patient’s blood is slowly withdrawn (usually about 5 to 20 mL at a time, depending on the patient’s size and the severity of illness) and a slightly larger amount of fresh, prewarmed blood or plasma flows into the patient's body. This cycle is repeated until the correct volume of blood has been replaced.
After the exchange transfusion, catheters may be left in place in case the procedure needs to be repeated.
In diseases such as sickle cell anemia, blood is removed and replaced with donor blood.
In conditions such as neonatal polycythemia, a specific amount of the child’s blood is removed and replaced with normal saline, plasma (the clear liquid portion of blood), or an albumin solution. This decreases the total number of red blood cells in the body and makes it easier for blood to flow through the body.
Medical Uses
Sickle Cell Disease
Exchange transfusion is used as an emergency procedure to treat life-threatening complications of sickle-cell disease as well as an elective procedure to stop these complications occurring.
Treatment of life-threatening complications
Prevention
Prior to surgery in people with sickle cell anemia (HbSS) who already have a hemoglobin above 85g/L, or who require a prolonged operation with general anesthetic, or who need high-risk surgery
Hemolytic Disease of the Newborn
Polycythemia
Severe malaria
Risks
General risks are the same as with any transfusion. Other possible complications include:
- Blood clots
- Changes in blood chemistry (high or low potassium, low calcium, low glucose, change in acid-base balance in the blood )
- Heart and lung problems
- Infection (greatly decreased risk due to careful screening of blood)
- Shock due to inadequate replacement of blood
Recovery
The person may need to be monitored for several days in the hospital after the transfusion, but the length of stay generally depends on the condition for which the exchange transfusion was performed.
History
The technique was originally developed by Alexander S. Wiener, soon after he co-discovered the Rh factor.[5]
See also
- Plasmapheresis
- Neonatal red cell transfusion
- Hemolytic disease of the newborn
- Exchange transfusion in sickle cell disease
References
- ^ a b "Exchange transfusion". Nlm.nih.gov. MedlinePlus.
- ^ "Spectra Optia for automatic red blood cell exchange in patients with sickle cell disease | Guidance and guidelines | NICE". www.nice.org.uk. Retrieved 2019-01-04.
- ^ Davis, Bernard A.; Allard, Shubha; Qureshi, Amrana; Porter, John B.; Pancham, Shivan; Win, Nay; Cho, Gavin; Ryan, Kate (2017). "Guidelines on red cell transfusion in sickle cell disease. Part I: principles and laboratory aspects". British Journal of Haematology. 176 (2): 179–191. doi:10.1111/bjh.14346. ISSN 1365-2141.
- ^ "Evidence-Based Management of Sickle Cell Disease: Expert Panel Report, 2014 | National Heart, Lung, and Blood Institute (NHLBI)". www.nhlbi.nih.gov. Retrieved 2019-01-04.
- ^ "Alexander Wiener biography". Bbguy.org.